VOLUNTEER APPLICATION FORM
Date Of Birth
Have you ever been convicted of a crime other than a traffic violation?
If yes, what was the charge?
May you be called at work?
Brief description of work:
Formal Education (highest year of school completed):
Do you speak a foreign language?
If yes, which?
Do you drive?
Do you have regular access to a car?
What timeframe(s) are you able to volunteer?
Are you available to work evenings?
Have you ever worked in a volunteer position before?
If yes, list current and previous volunteer work (please include brief description of duties, activities and dates of service):
The following volunteer positions are available:
Food and Clothing Distribution - Distributing food and clothing to needy women and children
Entrepreneurship - Teaching youth once a week the tools to start a business, marketing, and developing a business plan - Will use the Resource Book to teach – “Biblical Entrepreneurship”
Mentoring Youth - Teach youth once a week, how to accept discipline and moral values; image building, how to communicate effectively; how to develop positive attitudes; prevention of substance abuse and negative behavior
One-on-One Personalized Assistance - Once a month going to women’s houses who are temporarily shut-in due to illness or maternity, and providing the following services: light house cleaning, laundry, cooking and transportation to doctor visits
List skills relevant to the position for which you are applying:
Current community activities:
Why would you like to volunteer?
How did you learn of our program?
As a volunteer/intern with El Shaddai Empowerment Ministries, Inc., I understand I will be volunteering, either directly or indirectly, with refugees who are one of the most vulnerable populations being provided service by the agency. I understand that compliance with all of the requirements below for myself and my children are mandatory for volunteerism with El Shaddai Empowerment Ministries, Inc. for everyone’s safety: 1. The references I listed may be contacted by telephone or email. 2. I understand that El Shaddai Empowerment Ministries, Inc. has my permission to use my name and photographs of me to promote the organization. 3. I will inform a El Shaddai Empowerment Ministries, Inc. Staff or the Volunteer Supervisor of any previous injuries that may affect my ability to safely complete volunteer tasks, including lifting. 4. I understand that I must carry my own health insurance. I will not hold El Shaddai Empowerment Ministries, Inc. responsible for any unforeseen injuries or problems that may occur on the job. 5. I understand I may not initiate or engage in any media/public event pertaining to a refugees or the organization without the approval of El Shaddai Empowerment Ministries, Inc.. Requests for media engagements will be referred directly to the El Shaddai Empowerment Ministries, Inc. Staff or Volunteer Supervisor. 6. I understand that I have the right to submit a grievance to the Executive Director of El Shaddai Empowerment Ministries, Inc. should I not be satisfied with the response to the needs of, the interaction with, guidance of, care for refugee families within the scope of El Shaddai Empowerment Ministries, Inc. mission. 7. I understand that El Shaddai Empowerment Ministries, Inc. is a group of volunteers that help set up households for refugee families and does not provide any ongoing case management for the families. For the protection of the refugee family, I will contact and work with the refugee’s resettlement agency before continuing to visit them beyond work with El Shaddai Empowerment Ministries, Inc.. 8. I will not abuse, neglect, exploit, coerce, manipulate, retaliate against or deny food or any other basic necessities to refugee families. 9. I understand that I am expected to report any incident, action or circumstance which I may become aware of that presents a threat, endangerment, or poses a current or future impact on refugee families to the a El Shaddai Empowerment Ministries, Inc. Staff or Volunteer Supervisor. I understand that it is especially important to inform the Staff or Volunteer Supervisor in the case of a medical emergency, in the case of a pertinent medical update or in the case of a client’s harmful threat to self or others. 10. I understand that I may not be alone in the company of minor children without the presence of a legal guardian. I will not transport minor children for any purposes without the accompaniment of a legal guardian and expressed consent of El Shaddai Empowerment Ministries, Inc. following a fingerprint background check. 11. I understand that I may receive personal information regarding a refugee family on an as needed basis and a refugee family may choose to disclose information. I understand that refugee information is confidential, especially addresses and contact information, and that it is not to be disclosed to an outside party in written or verbal form, nor in an electronic communication such as mail, website accessible by public, etc. 12. Many refugee clients choose not to have their photos taken for personal and/or security reasons. I understand that I may not photograph nor arrange for a photograph of refugee families without first receiving approval from the El Shaddai Empowerment Ministries, Inc. Staff or Volunteer Supervisor to ensure that El Shaddai Empowerment Ministries, Inc. has obtained expressed written consent on a El Shaddai Empowerment Ministries, Inc. consent form. 13. I understand all refugee families are to be treated with dignity, respect and consideration and are not to be discriminated against based on race, national origin, religion, gender, sexual orientation, age, disability or marital status. 14. I understand that the terms listed above are not all-inclusive and may be updated, as needed.